Provider First Line Business Practice Location Address:
130 UPTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-621-4946
Provider Business Practice Location Address Fax Number:
956-621-4950
Provider Enumeration Date:
01/07/2009